An immunohistological, biochemical and microbiological study of PMR
Research type
Research Study
Full title
An immunohistological, biochemical and microbiological study of subacromial bursal tissue and fluid using ultrasound guided portal assisted biopsy in polymyalgia rheumatica
IRAS ID
117587
Contact name
Professor Bhaskar Dasgupta
Contact email
Sponsor organisation
Southend University Hospital NHS Foundation Trust
Research summary
Polymyalgia Rheumatica (PMR) is one of the commonest inflammatory disorders affecting older people. It is diagnosed in patients >50 years of age, presenting with pain and stiffness in the shoulder and pelvic girdle, combined with clinical and laboratory features of inflammation. The exact cause of PMR is not known. There is an unmet need for better understanding, diagnosis and management of this condition. Although use of steroid therapy is the current practice it only suppresses signs and symptoms of PMR. It is unable to prevent multiple flares and severe long-term side effects. Better understanding of the cause of PMR will drive the development of more effective novel therapies with a benefit/risk ratio greater than the current standard of care.
We know that pain and stiffness in shoulder and pelvic girdle can be a feature of several other elderly onset inflammatory diseases. The utility of ultrasonography for diagnosis, assessment of disease severity and treatment response in PMR is now established. Recently published international classification criteria for PMR (by Prof Dasgupta and colleagues) emphasized the importance of ultrasound detected inflammatory changes in shoulder joints in the diagnosis of PMR. Contrast enhanced ultrasound is a recent technique that adds to traditional ultrasound techniques by detecting inflammatory changes more accurately.We propose to use contrast-enhanced ultrasound to identify and evaluate inflammatory changes in new PMR patients prior to steroid therapy. A portal assisted ultrasound guided technique will be used to obtain a small tissue and fluid sample from the inflamed structures identified with help of contrast-enhanced ultrasound. Tissue and fluid so obtained will be used for a study of biochemical, immuno-histological, cytokine and microbiological characteristics of the inflammatory lesions in PMR. A control study will also be undertaken of other inflammatory (e.g. Rheumatoid arthritis) and non-inflammatory conditions (such as osteoarthritis) that can mimic PMR.
REC name
London - London Bridge Research Ethics Committee
REC reference
13/LO/0790
Date of REC Opinion
6 Aug 2013
REC opinion
Further Information Favourable Opinion